A client with acute kidney injury is admitted to the intensive care unit. The client's serum potassium level is mEq/L ( mmol/L), and the bedside cardiac monitor shows a widened QRS complex with tall, peaked T waves. The healthcare provider prescribes several interventions. In what order should the nurse execute these actions? Arrange the sequence from first to last.
- 1Administer intravenous calcium gluconate.
- 2Administer intravenous regular insulin concurrently with dextrose.
- 3Auscultate the abdomen for the presence of bowel sounds.
- 4Administer oral sodium polystyrene sulfonate.
- 5Draw a venous blood sample for a repeat basic metabolic panel.
Cevap
The correct sequence is to first administer intravenous calcium gluconate, followed by intravenous regular insulin and dextrose, then auscultate for bowel sounds, administer oral sodium polystyrene sulfonate, and finally draw a venous blood sample for reassessment.
The management of severe hyperkalemia with electrocardiographic changes follows a strict physiological priority to prevent cardiac arrest. Calcium gluconate is administered first to immediately stabilize the cardiac membrane. Next, regular insulin and dextrose rapidly shift potassium from the intravascular space into the intracellular space. Before administering sodium polystyrene sulfonate for permanent potassium removal, the nurse must assess for bowel sounds to prevent intestinal necrosis. Finally, a repeat blood draw evaluates the effectiveness of these sequential interventions.
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Anahtar Kavram
Prioritization of severe hyperkalemia management follows a specific physiological sequence: stabilize the myocardium, shift potassium intracellularly, remove potassium from the body, and evaluate therapy.